Pediatric Urology Section of Urology, Department of Surgery, University of Chicago Comer Children's Hospital & Pritzker Medical School, Chicago, Illinois 60637, USA.
Curr Opin Urol. 2011 Jul;21(4):314-21. doi: 10.1097/MOU.0b013e3283476f23.
Robot-assisted laparoscopic surgery (RALS) is evolving rapidly in the pediatric surgical field. The unique attributes of the robotic interface makes this technology ideal for children with congenital anomalies who often require reconstructive procedures. Furthermore, the system can generate extremely delicate movements in a confined working space such as the one generally found in the pediatric population. Herein, we critically review the current experience with RALS placing a special emphasis in children undergoing complex reconstructive surgical procedures worldwide.
A total of 42 original manuscripts on a variety of robot-assisted urologic surgical procedures in children were identified from a MEDLINE database search. Complex reconstructive procedures that are being currently performed include reoperative pyeloplasty, pyeloplasty in infants, pyelolithotomy, ureteropyelostomy/ureterostomy, bladder augmentation with or without appendico-vesicostomy, bladder neck sling procedure, among others.
Initial results with robot assistance are encouraging and have demonstrated safety comparable to open procedures and outcomes at least equivalent to standard laparoscopy. Future development of smaller instruments, incorporating tactile feedback, will likely overcome current limitations and spread out the use of this technique in younger children and more advanced procedures.
机器人辅助腹腔镜手术（RALS）在小儿外科学领域发展迅速。机器人接口的独特属性使其成为治疗先天性畸形儿童的理想选择，因为这些儿童通常需要进行重建手术。此外，该系统可以在狭小的工作空间（如儿科人群中常见的空间）中产生极其精细的运动。在此，我们对 RALS 的现有经验进行了批判性评估，特别强调了全球范围内接受复杂重建手术的儿童。
通过 MEDLINE 数据库搜索，共确定了 42 篇关于儿童各种机器人辅助泌尿科手术的原始论文。目前正在进行的复杂重建手术包括再发性肾盂成形术、婴儿肾盂成形术、肾盂切开取石术、输尿管肾盂吻合术/输尿管造口术、带或不带阑尾-膀胱吻合术的膀胱扩大术、膀胱颈吊带术等。
机器人辅助的初步结果令人鼓舞，其安全性与开放手术相当，结果至少与标准腹腔镜相当。未来更小的器械的发展，结合触觉反馈，可能会克服当前的限制，并将该技术应用于更小的儿童和更先进的手术中。
